Making end-of-life decisions

Preparing for death is never an easy subject to broach. Whether death comes as a shock through sudden circumstances or expected after a long illness, most people don’t feel comfortable

discussing final wishes or end-of-life preparations with family or friends. For Catholics, being informed and prepared prior to death can ensure not only that final wishes are followed, but that the Church’s teachings on end-of-life decisions are respected as well.

The steps necessary to prepare Catholics to make informed end-of-life decisions were discussed at a recent seminar at Holy Family Church sponsored by the diocesan Respect Life Office. Kathleen Gallagher, director of Pro-Life Activities and Catholic Action Network for the New York State Catholic Conference, and Dr. Anthony Oliva of St. Joseph’s Hospital in Syracuse and director of the Syracuse Catholic Medical Association, conducted the seminar.

Church teaching calls Catholics to respect and take every step necessary to protect human life. However, in light of advances in medical technology, the steps that are necessary and morally obligated can be complicated to determine. According to Now and at the Hour of Our Death: A Catholic Guide to End-of-Life Decision-Making prepared by the Catholic Bishops of New York State, Catholics “must always provide ordinary medical means of preserving life.” The term “ordinary” means any treatment that offers “a reasonable hope of benefit and would not entail excessive burden” on the patient, family or the community. Providing ordinary treatment is morally obligatory for Catholics. However, there are treatments that are not morally obligatory. These treatments are considered “extraordinary” because the end result is unequal to the burden and/or consequences they would cause to the patient.

“Intention is critical,” explained Gallagher. “There are the moral principals we hold and there are the laws and policies of New York State. Every life is deserving of respect and protection of the law, but there is no set list of what is considered ordinary or extraordinary means of treatment because every situation is unique. There are many factors to consider and what could be considered ordinary treatment in one case could be considered extraordinary in another.”

Gallagher offered attendees a specific example. “Is a ventilator considered ordinary means to preserve life or is it extraordinary? It depends on the circumstances. A ventilator may be used for a few days to assist a relatively healthy person to recover from a bout of pneumonia. In this case the use of a ventilator would be considered ordinary and morally obligated. But if that same ventilator was used on a terminally ill patient whose death is imminent and the act of using the ventilator would cause severe pain and distress to the patient without any beneficial results or ability to prolong life, then the ventilator would be considered extraordinary means and is not morally obligatory. It’s important to understand that there is no black or white when it comes to end-of-life decisions: it’s a lot of shades of gray.”

Gallagher also pointed out that in certain cases, a patient may not want extraordinary means taken, but may be unable to voice this decision to medical professionals or family members. To ensure that a patient’s wishes are known during treatment decisions, Gallagher suggested Catholics should choose a health proxy.

A health proxy is an individual who is selected personally by the patient and is empowered to make medical decisions on behalf of the patient when he or she is no longer able to do so. Anyone can create a health care proxy form. A lawyer is not required but the document does require the signature of two adult witnesses. A health proxy form does not have to be notarized and should be given to the doctor upon a patient’s admission to a hospital. Even with signed health proxy forms, patients can make their own health care decisions as long as they are able to do so.

Having a health proxy is not the same thing as having a living will, a DNR (Do Not Resuscitate order) or a MOLST (Medical Order for Life Sustaining Treatment), and Gallagher pointed out that it’s critical Catholics understand the role of each before choosing one or signing something they don’t fully understand.

A living will is a legal and medical document that provides written instruction on a patient’s wishes to medical personnel. A living will, Gallagher cautioned, is limited and inflexible, and is not a preferred document by the Church because it vests power to paper instead of a person.

A DNR, explained Gallagher, deals only with CPR and instructs medical and emergency personnel not to perform CPR in the event a patient’s heart or breathing stops.

A MOLST extends beyond CPR and allows for drugs and medically assisted food and hydration. A MOLST converts treatment preferences into an actionable medical order and all health workers and emergency responders must comply with the order, which supersedes any previous advance directive from the patient. In the case of a MOLST, even if the patient has the ability to make his or her own decisions, once signed, the MOLST is applied to a patient’s case immediately.

“A MOLST is often encouraged in a hospital but it is not required,” stated Dr. Oliva. “There is a box that can be checked stating the patient declines to sign the MOLST. Too many patients misunderstand the form and just check all the boxes not realizing what the form is actually stating.”

“A MOLST is like a living will on steroids,” stated Gallagher. “It combines all other directives into one main form but it was originally created for patients with less than six months to live. Today, the MOLST is now being used for non-terminal patients and it relies on checking boxes to indicate what care should or shouldn’t be provided. Choosing a health proxy for Catholics is considered morally appropriate because a health proxy has the flexibility to react to each specific medical situation in accordance with a patient’s wishes and religious beliefs. I know people are afraid to talk about death, but the Church doesn’t believe that life should be reduced down to a checked box. There are resources available to help Catholics do due diligence before a serious medical situation occurs.”

For more information on end-of-life decisions, contact the New York State Catholic Conference at (518) 434-6195 or info@nyscatholic.org, or visit www.nyscatholic.org.